Innovative Service Design

I have been working with a council who, like all of the public sector in the UK, needs to reduce costs - and maintain or improve service. Luckily they did not want to go down the route of simply reducing activities, the director was aware of other approaches. Two years prior, he had already re-organised his Anti Social Behaviour (ASB) officers into a Community Protection group. And they had direct access to working with other council services, social care and mental health through the MASH. Some of these services had been formed in to an integrated Hub.

So, with a Hub what was more of there to achieve, it looked like it was all working well? The director still thought there were improvements to be made. And he was right. I took a small team of front line staff through two steps;

Phase 1 - get knowledgeWe looked at the current system, and these are some of the highlights of what we found for ASB;43% demands actually go unresolved, especially those sent to the MASH.25% were repeat demands80% people they dealt with related to the council social housing tenantsThe officers were only able to actually add value in 33% of cases.

The front-line team and the managers were shocked! They were already formed into a Hub, so they thought they were working in an good integrated way. This information was unknown to the managers as no-one in the current system was paying attention to this. From the data above, there are opportunities for efficiency gains and better service possibilities here.

The difference with Phase 1 is that the team were looking at the current service from a different perspective to what they had before.

Phase 2 - trial a new designSo, the same team were tasked with coming up with a better way of working. And they started by taking the next random demand in the Hub, and then understanding more about the person who was complaining.

Case study

The first demand we took in the new way

The demand from Tracy was help, there is anti-social behaviour around me.

It took two visits to find out:

that actually she wanted to move to another area of the town, and there was no real ASB.

Tracy is in her early twenties, and she has some difficulties - she suffers quite badly from anxiety. She made herself homeless when she was 11, and became pregnant at 16. Her relationship with her father is poor.

We listened, and one of the officers happened to have some basic training with dealing with anxiety. At the end of the second visit, we asked her about her level of anxiety - it originally was a 4 out of 10 when we started, and was now a 7. And she was very happy that we had not judged her when she explained about her problems.

So, we had given Tracy advice on how to move elsewhere, and given her anxiety coping advice. told us that she had been having great difficulties getting repairs done with the housing provider.

On the next visit she welcomed us with an open attitude of trust. We helped her to deal with the communication problems with her housing provider. She told us that we had given her confidence and that she had been for an interview for work. She had talked to her father and she had more control over that relationship. She came to the council to see about a house-swap.

After a few weeks, Tracy did not want to move anymore. She stopped calling us, and was looking forward to being a mother again. She was thinking of starting an education course. She gave us a 10 out of 10 for our support, which she said that it was our support that was what helped her get her confidence back.

The case study may not seem much, it was a small change in method for the wardens. The different is in the attitude and how the decision-making occurred.

Learning from the Case Studies

To sit together is not enough - its not enough to simply create an integrated Hub, or rely on a MASH team. These are important structural changes, but on their own do not integrated workflow, or develop a new way of working.

We cannot afford it - Many managers reading this probably thinks that this is far too expensive an approach to be realistic - to treat all demands differently. And maybe concerned that our wardens should not become 'social workers'. What actually happened is that our officers already knew how to navigate the public sector network of advice, and we did two important things:

Listen, to allow Tracey to get to the root cause of her issues.

Give simple suggestions of ways forward, and signpost to other services.

Despite the change in working, the wardens skill set remained relatively unchanged.

We took a total of 13 demands in the first part of the trial, and we followed a similar pattern. Each case was different, but the same officers dealt with each one. When they needed support, or expertise they did not have, they would come back to the office and the new way of working enables this to be available to them.

We recognised, in some of the 13, that this approach is a type of early intervention, contributing to the prevention of complex troubled families.

Outcome - reduction in resources and improved service

What about the outcomes? Well, lets look at the actual figures;

33 - 42% actual less time spent dealing with the demands,0% repeat demands after six weeks of recording,Feedback out of 10; 10 - five 9 - two 8 - one

How do you think the manager took this? Well, they still cannot believe it, as it goes against what they thought - that if you deal with a demand in a unique way, that it will cost more.

The manager also thought their staff were already working in this 'listening' way. And due to the enforcement actions of Housing who were trying to cut their own department costs, they learned that this was causing lots of increased work onto the Community protection team.

Implementation

The service is now in the process of rolling in all their staff to work in the new way. It does not take long, four days for each front line staff, and then everyone will be trained up in the new system. By taking in demands that are mainly low to medium complex, it also slots neatly into two complex family initiatives that is being used in the county.

One of the key changes that has occurred is in culture and management style. Culture change - the culture has changed to one where officers learn from each other all the time - continuous improvement is now part of how they all work. Each case is written up in a visible matrix, which is visible to all.

Manage the work - the manager brings together teams of officers to review what are on their matrices, and ensure they are getting support when it is needed. the manager remains connected to the real work, rather than sitting glued to a screen looking at prioritised lists.

The public - the demands now are resolved in a very different way. The service user is directly participating in the resolution and takes responsibility get the issues resolved. The officer supports that process.

The next stepsThe whole review took four months to conclude, and they have:

new set of principles and process of work, replacing their old procedures

the manager now has a coaching approach to developing her staff

staff morale is far higher

developing working with partners in a more engaged way is the next step

they should exceed their cost reduction target

they are compiling real time information about root cause and skills they will need to reduce demand in the long term

to incorporate this approach into Housing.

Approach

Managers in local authorities have been inundated with so called best practice initiatives over the past decade. Maybe, finally, we are being allowed to implement an approach that actually follows the complexity and variability of how individuals and families actually behave. It tackles the real causes... This approach evolves the organisation to a more enlightened way of working.

And its cheaper to do it this way!

The techniques the team used in Phase 1 & 2 were actually straightforward, when they learned the new techniques. They had to:

Analyse their performance form a different perspective, an external viewpoint.

Learn how to identify value work.

Learn how to identify the root cause of issues.

Learn how to identify level of need.

How to retain ownership and deal with wicked problems.

What was difficult for managers was recognising that staff were not actually doing all these things managers thought they were doing!

The council used a participative approach where the consultant was used, not to do the review, but to lead a team of staff through the transformation methodology. This is ensuring true learning and sustained knowledge is retained in the organisation. It also minimises the cost of using the consultant.

Maybe this approach may slow down the review, it may not discover quite as much. But out of all that I have learned in almost two decades of change, the staff and managers in the organisation must do this for themselves for it to truly work.

Methodology

The methodology applied here is systemic. The perspective used in this approach is and based on designing work around value and the complex needs of the individual. It is an example of a transformation rather than a change, transformation because it needs managers to change their current perspectives of council services, which then allows so many other aspects to change. The overall approach is through a systems thinking understanding of the work.

The team had to learn about certain key concepts;

the triangle of need,

standardisation vs. variation,

purpose vs. procedures,

how to change culture, in particular redefine their enforcement attitude

It can be easily done by every public sector service, but it requires managers to honestly be open to learning about their service and their approach to management. It has many similarities with the Toyota System, and Demings teachings.

I was reading an article writen by John Bird, he of the Big Issue. In it he talked about the benefits system, the TV programme Benefits Street, and the ability to 'benefit' people. He has hit on a point that has been demonstrated in the last few years, by a few people.

In Stoke on Trent, they have experimented with trying a different way to deal with people who are struggling with something in their lives. This struggle is affecting them in ways like an inability to pay rent, running out of money, needing to get on the waiting list, etc.

What the team did was to take some people in need, and ask them what problems did they have that they needed help with? And whatever they said, the team would go about helping the person to fix that problem. It was that easy.

Chief executives from a range of public sector partners has agreed that the team has the ability to pull on any service they needed to to get the competence to fix the problem. In addition, the action they took and money they needed to put towards helping that person, was available to be spent.

The team took cases, and the first step was to understand the problems the person was facing, and the nature of their problems in the context of their lives. The next step was to then do only what is necessary to help the person resolve their problems.

What was found, was that the people they took, had a range of interdependent problems, that often took time to properly understand. Often, people were wary of this approach from an organsiation they did not trust.

Then, the team found that the problems that were presented with, were not usually solved by taking the standard approach that that service would normally take. For instance, if someone wanted to move, the first thing to do is to understand the reason for the move. It was discivered that most people who wanted to move, actually had problems that could be resolved, that meant that they then did not need to move.

The outcome is that the people with needs to be resolved, actually had their problems fixed, or had ways that they could continue to resolve the issues on their own. The majority of people that went through this system accepted the help, and the outcomes were positive in every situation.

It is difficult, in a short time to view actual financial benefits. However, the team calculated that for seven cases, the difference in the cost of the work done was £104,000 less in the new way. Even understanding that this figure is an estimate, the amount is staggering.

Another outcome, and one that is just as important, is the impact it had on the people. The intervention on each person was aimed at re-balancing them so that they could then continue to live their lives to develop into becoming independent of the welfare system.

The reason I wrote this example now is that John Birds article said that the benefits system should 'benefit' people. Benefit people in need, to help them to fix problems and improve their lives. The work that has been trialled, using a systems thinking approach, shows that this is not only possible, but that it actually reduces the cost to the whole system. The cost further reduces over time, as people are less dependent and more in control of their lives.